Two-person assist: when a ride needs a second crew member
Overview
A two-person assist means the transportation company sends a second trained crew member, beyond the driver, because one person cannot move the rider safely. Stretcher trips need two people in Virginia, New York, Georgia, and Oklahoma. Stairs with no ramp, riders too heavy for one helper, and riders who need someone beside them the whole way are the other common reasons.
On this page
What a two-person assist is
A two-person assist is a ride staffed by the driver plus a second trained person from the transportation company, because the rider cannot be moved safely by one. The second person is crew, not company for the rider. That separates it from an escort or attendant the rider brings along, such as a parent or caregiver.
Payers draw the same line. Indiana’s Transportation Services module (version 6.1, August 19, 2025) says the additional attendant must be an employee of the billing provider. Illinois’s transportation handbook (March 11, 2024) counts as an employee attendant anyone besides the driver on the payroll of the medicar, service car, or taxi company, and puts either kind of attendant through prior approval case by case.
A second person does not make lifting safe. Safe patient handling guidance from the Veterans Health Administration, reprinted by NIOSH in 2009, says that once a caregiver would be lifting over 35 pounds of the patient’s weight, the patient counts as fully dependent and devices should do the work. Safe passenger transfers covers the methods.
When does a ride need a second crew member?
Rules and payers call for a second person in these situations:
- Stretcher trips. Virginia (updated May 26, 2026), New York, and Georgia (manual version October 1, 2026) all put at least two people on a stretcher trip. Oklahoma’s rule 310:641-17-8 also requires the attendant to hold Emergency Medical Responder certification. The full crew rules are on stretcher transportation.
- Stairs with no ramp. Indiana’s example of a paid extra attendant is a wheelchair rider who lives upstairs in a home with no ramp. Massachusetts writes stairs into its wheelchair van rule, 130 CMR 407.471: the service covers members who must be carried up or down stairs because they cannot manage stairs or cannot walk without two people helping.
- Larger riders. Colorado covers its XL wheelchair service, from November 1, 2025, only when two attendants help load and unload the member. The equipment side is in bariatric transportation.
- Riders who need someone beside them. Kentucky’s statute, KRS 281.873, makes the transportation provider supply one escort per vehicle when a rider’s physician, physician assistant, advanced practice registered nurse, or qualified mental health professional recommends one because of a history of harmful behavior. The provider also supplies one when a rider needs a hand between the door and the van and that help would take five minutes or more, or the driver could not keep sight of a van with other riders still inside.
- Lifts and transfers that take two. Riders moved with a mechanical lift bring their own staffing rules, covered in Hoyer lift riders.
How payers treat the second person
Payers handle the cost in three ways. Some pay a small add-on, some make two attendants the condition of a higher rate, and some count a second person as part of the base rate. Indiana, Minnesota, Colorado, Connecticut, and Medi-Cal are compared in bariatric transportation cost, and the attendant code several states use for it is explained under T2001.
Ohio is another add-on state. The appendix to its payment rule, 5160-15-28 (rule effective August 1, 2026), lists T2001, attendant on a wheelchair van, at $15.00, a figure unchanged since January 1, 2024. Oregon’s brokerage payment rule shows the other side: OAR 410-136-3220 says brokerages do not pay subcontractors for time spent helping clients in or out of a vehicle.
What to record when two people ran the trip
Write down who the second person was and why they were needed, on the trip itself:
- The reason. Indiana wants the need for an additional attendant documented on the driver’s ticket, and it may review that after payment. Ohio’s manual review requests ask for a justification for the attendant.
- The name. Minnesota’s trip record rules list the name of the extra attendant among the 14 items a record must carry when one is used.
- The count. Indiana caps the extra attendant at two units, and says one is usually enough.
In HealthRide, the wheelchair or stretcher need stays on the trip so it is matched to an equipped van, and dispatch can send the crew the stair or transfer details in team chat.
Frequently asked questions
- Can a family member be the second person on a two-person assist?
- Not when the payer is paying for crew. Indiana requires its additional attendant to be an employee of the billing provider. Illinois separates an employee attendant, who works for the medicar, service car, or taxi company, from a non-employee attendant such as a family member, and only a medicar may bill both on one trip. A relative riding along is an escort, not crew.
- Does the second crew member have to ride the whole trip?
- It depends on why they are there. Indiana's extra loading attendant does not have to stay for the trip once the rider is loaded. Stretcher rules are the opposite: Virginia keeps that second person seated in the back with the stretcher passenger whenever the van is moving, ready to alert the driver if the rider's condition changes suddenly.
- Is two-person assist the same as hand-to-hand service?
- No. Hand-to-hand describes the handoff at each end: a caregiver passes the rider to the driver and the driver passes the rider to a caregiver. A two-person assist is about how many trained staff it takes to move the rider. A trip can need one, the other, or both.
